States slashing already scarce oral health services to poor

Dental care for rural, minority, and poor communities is hard to find

Very few state governments offer dental coverage in their Medicaid programs, and those that do are slashing those benefits. Recently, Governor Pat Quinn of Illinois cut $1.6 billion out of the state’s $15 billion Medicaid budget, reducing the state’s adult dental coverage to emergency tooth extractions only. In a further assault on Illinois’ poor, the state slapped a new co-payment on prescription drugs. About half the states in the country only cover dental emergencies and pain relief.

In the ramp up to broadening Medicaid coverage in 2014 under the Affordable Care Act (ACA), many state governments are looking for ways to cut their benefits. The ACA prohibits states from tightening eligibility for Medicaid coverage. However, there are no restrictions on cutting “optional” benefits such as dental, vision, and prescription coverage. State governments across the country are using this loophole to deny billions of dollars in benefits to the nation’s poor.

Unfortunately, even in states where Medicaid pays for preventive (cleaning) and restorative (fillings and root canals) dental care, finding dentists who accept the government insurance is next to impossible. Here, in Charlottesville, no dentists take Medicaid. Poor working people are forced to go to the local free clinic, where the waiting list is months long, to obtain dental care. In many rural and minority communities, no dentists are even available. Access to oral health care is even more difficult than access to other physical health care.

Poor oral health leads to disease in the mouth, teeth, and gums; it also is a major cause of other systemic chronic illnesses. Poor oral health increases the risk of various lung diseases, has been linked to an increased incidence of diabetes, and is associated with an increased incidence of pre-term birth of low-weight babies (who are at increased risk of chronic illness in childhood).

We need more dentists and more dental hygienists. Physicians, nurse practitioners, and physician assistants should be trained to provide preventive dental services and emergency dental care. And, of course, provide health care — including oral health care — to everyone as a basic human right through establishing a federally funded, national health service.